Jinzhong News from Yellow River News Network (correspondent Song Pengliang) Budd-Chiari syndrome (BCS) is a retrohepatic disease caused by obstruction of the hepatic vein and inferior vena cava due to stenosis or occlusion of the hepatic vein and inferior vena cava. portal hypertension, lower extremity edema and a series of symptoms. At present, BCS is divided into hepatic vein type, inferior vena cava type and mixed type by simple classification method, and inferior vena cava stenosis or obstruction type is more common in China.
Recently, a male patient was admitted to the Interventional Vascular Department of Jinzhong First People’s Hospital due to “pigmentation of both lower extremities with skin ulceration”. Before admission, the color Doppler ultrasound of the lower extremity blood vessels was completed in the local county hospital. CTA of the lower extremity arteries showed that the bilateral lower extremity veins, iliac veins, and inferior vena cava were partially filled with crescent-shaped imaging machines.
Before surgery, it was considered to be lower extremity varicose veins with stasis dermatitis and ulcers. In order to further confirm the diagnosis, lower extremity venography in the interventional vascular department showed slow bilateral common iliac venous return, internal iliac venous reflux, bilateral The tortuous and dilated lateral abdominal wall veins were obvious. Later review of the inferior vena cava angiography showed that the inferior vena cava returned through the collateral circulation, and the posterior segment of the inferior vena cava was unclear. The diagnosis of Budd-Chiari syndrome was made.
Chronic venous disease (CVD) is a syndrome characterized by a series of symptoms and signs caused by abnormal venous structure or function, resulting in poor venous return and high venous pressure, lower extremity composure, fatigue , Pain, edema, varicose veins, skin nutritional changes and venous ulcers are the main clinical manifestations.
Factors that contribute to chronic venous disease include: venous reflux, impaired venous return, congenital developmental abnormalities, and genetics. Therefore, Budd-Chiari syndrome is one of the important causes of venous return disorders.
In order to relieve the venous hypertension caused by the poor venous return of the lower extremities and improve the nutritional status of the skin, under the leadership of Director Hao Yajun, the Interventional Vascular Department of Jinzhong No. Rups-100 is placed in the inferior vena cava of the hepatic vein segment, and a 5F pigtail catheter is sent to the inferior vena cava for angiography.
The right femoral vein was used to puncture the blood vessel. Seldinger was used to puncture the femoral vein and a 5F pigtail catheter was sent to the inferior vena cava for angiography. A successful puncture was made through the occlusion of the inferior vena cava to the distal end of the inferior vena cava and a guide wire was introduced.
8mm×60mm, 12mm×40mm, 14mm×40mm, 16mm×60mm were placed along the guide wire to dilate the occlusion segment of the inferior vena cava, and then a 16mm×60mm balloon was placed through the internal jugular vein 10F sheath. To the occlusion segment of the inferior vena cava, a 12mm×40mm balloon was placed through the femoral vein at the same time, and the two balloons were expanded at the occlusion site at the same time. The re-examination angiography showed that the blood flow of the inferior vena cava was significantly improved compared with the previous one. Postoperatively, the lower extremity bulge of the patient was significantly relieved, and the ulcers near the ankle joints of both lower extremities gradually shrunk and healed.
The etiology of Budd-Chiari syndrome is complex and the pathogenesis is still unclear. Surgical septum resection and liver transplantation have good therapeutic effects. Serious complications occurred. With the rapid development of endovascular interventional therapy technology, endovascular interventional therapy has gradually become the first choice for the treatment of BCS due to its advantages of minimally invasive, high efficiency, and safety.
Through minimally invasive interventional therapy, the patient’s occluded blood vessels can be opened accurately and symptoms can be relieved. The doctor reminds that when there are symptoms such as unexplained ascites, edema of both lower extremities, hepatosplenomegaly, abdominal varicose veins, lower extremity ulcers, and gastrointestinal bleeding, it may be the manifestation of “Buddha syndrome”, and you should go to a regular hospital in time. See a doctor.
[Editor: Bing Yi]